Systematic Review of Cost-Effectiveness of CDK 4/6 Inhibitors in Treating Breast Cancer

From the 2022 HVPA National Conference

Anjali Bhatt BSA Biology (Texas A and M College of Medicine), Jennifer Nwosu BS Biology, Lixian Zhong PhD

Background

Drug costs account for approximately 20% of the total cost of cancer care in the US. High drug costs lead to economic burden to the health care system and society overall and can be detrimental to patients’ affordability of medications due to high out-of-pocket costs.

Objective

The study aimed to systematically assess the cost-effectiveness evidence of Cyclin-Dependent Kinase (CDK) 4/6 inhibitors in the treatment of HR+/HER2- advanced breast cancer from a US societal/payer’s perspective.

Methods

A literature search was conducted on PubMed. Two independent reviewers: 1) screened title/abstract and assessed full text to determine whether studies met inclusion criteria; 2) used Drummond checklist to rate the quality of the studies; and 3) extracted key information from the identified studies.

Results

Of the 201 records screened by title/abstract, 11 articles met the inclusion and exclusion criteria and were included in the final analysis. Among the 11 studies included in this review, 4 found CDK 4/6 inhibitors to be cost-effective, while the other 7 found it not to be a cost-effective option with the drug cost being the main cost driver.

Conclusion and Clinical Implications

Cost-effectiveness evidence is important for formulary decisions and can facilitate evidence-based practice by optimizing the appropriate use of cost-effective treatment options. In addition, cost-effectiveness evidence supports value-based care. Patients that are diagnosed with cancer not only experience an impact on their health, but on their quality of life as well. A factor that plays into quality of life is the fundamental financial impact and its role. Financial toxicity is used to describe the burden of out-of-pocket costs for patients. Studies report that 20% of cancer patient’s income was reportedly spent on medical care and often had to miss work due to treatment resulting in lost productivity. Implementation of strategic cost-effective analysis of current breast cancer medications could not only improve our patient’s prognosis, but also enhance or maintain the quality of life and safety of our patients. Another significance of cost-effectiveness evidence is that it points to the importance of regulating clinical trial study design and methodology, which is vital because clinical trials provide data on drug-based outcomes. These outcomes are then used to determine drug cost. Future systematic reviews should be conducted on the quality of clinical trials measuring outcomes of CDK 4/6 inhibitors in the treatment of HR+/HER2- breast cancer.

Keywords

CDK 4/6 inhibitors; HR+/HER2- breast cancer; ribociclib; palbociclib; abemaciclib; letrozole; fulvestrant; cost-effective; systematic review

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